Discriminant value of serum HBV DNA levels as predictors of liver fibrosis in chronic hepatitis B.

Current guidelines recommend antiviral therapy in chronic hepatitis B (HBV) patients with significant histological disease. We aimed to compare histological fibrosis (METAVIR, ≥F2) in patients with HBV DNA ≥20,000 IU/mL vs. ≥2000 IU/mL and identify predictors of fibrosis. We performed prospective liver biopsies on 203 HBeAg-negative patients in four groups: Group I (n = 55): HBV DNA ≥20,000 IU/mL and persistently elevated alanine aminotransferase (ALT) levels (PEALT; >40 U/L); Group II (n = 34): HBV DNA ≥20,000 IU/mL and persistently normal ALT (PNALT); Group III (n = 40): HBV DNA <20,000 IU/mL and PEALT; and Group IV (n = 74): HBV DNA <20,000 IU/mL, and PNALT. We reanalysed all groups in relation to updated cut-off for treatable viremia (2000 IU/mL). Genotype D was detected in 86% of patients. Hepatic fibrosis ≥F2 was detected in 72.7%, 52.9%, 57.5% and 18.9% in Groups I-IV, respectively (P < 0.0001). Except in Group II with a trend for lower ≥F2 fibrosis (P = 0.067), there was no significant difference by using HBV DNA cut-off 20,000 vs. 2000 IU/mL. Multivariate logistic regression analysis identified study Group IV (OR, 0.0276; CI: 0.088-0.868; P = 0.0276) and milder (A0-1) necroinflammatory grade (OR, 0.135; CI: 0.063-0.287; P < 0.0001) as independent predictors of ≥F2 fibrosis. The specificity, positive and negative predictive values for PEALT in detection of ≥F2 fibrosis for viremia ≥2000 IU/mL (80%, 69% and 65%, respectively) or ≥20,000 IU/mL (86%, 73% and 63%, respectively) were similar, with a marginal gain in sensitivity (51% vs. 42%, respectively). Significant fibrosis is prevalent in a large proportion of HBeAg-negative patients with high viremia and persistently normal ALT. Lower HBV DNA cut-offs could be adopted with marginal gains in fibrosis detection and without loss of diagnostic accuracy.

Coexistence of malakoplakia and multifocal diffuse large B cell lymphoma of colorectum.

We report a case of concurrent multifocal diffuse large B cell lymphoma and malakoplakia of colorectum in a 36-year-old man presenting with recurrent bloody diarrhoea. Malakoplakia has been described in association with a variety of malignant and nonmalignant conditions. To the best of our knowledge, this is the third report of coexistence or association of malignant non-Hodgkin lymphoma and malakoplakia in the literature, and the first report ever in the colorectum.

Formol-ether concentration method in the diagnosis of active schistosoma mansoni in patients with detectable IHA.

Schistosomiasis is a world wide human infection. In Saudi Arabia there are multiple endemic foci. Various methods have been used to diagnose Schistosoma mansoni. We studied 1410 patients coming from S. mansoni endemic areas with detectable antibodies by indirect hemagglutination (IHA). Stool specimens were tested for S. mansoni ova by direct smear and formol-ether concentration (FEC) methods. The objective of the study was to identify patients with active schistosomiasis using FEC method and a single direct smear. Twenty percent of IHA positive patients had active infection detected by FEC, while a single direct stool smear diagnosed only 2.4% (P< 0.0001). The percentage of positive FEC was significantly increasing in linear trend with IHA level. This trend wasn't observed with direct smear examination. The current data suggest that FEC is helpful to diagnose active schistosomiasis, therefore it is recommended in IRA positive individuals.

Use of serum immunoglobulins G and A for detection of Helicobacter pylori infection in dyspeptic patients by enzyme immunosorbent assay.

Since the discovery of Helicobacter pylori (H. pylori), several invasive and non invasive tests have become available. The aim of this study was to test the performance of immunoglobulins IgG and IgA by using an enzyme linked immunosorbent assay (ELISA) test (In vitro diagnostika GmbH, Germany) for the diagnosis of H. pylori among dyspeptic patients. Blood samples from 152 dyspeptic patients and 51 asymptomatic controls were analyzed in a case control study. IgG and IgA were positive in 33.5% and 41.1% respectively compared to 13.8% for both IgG and IgA in controls (P=0.002). We support the future use of serology as a non invasive, and rapid test for the diagnosis of H. pylori infection among dyspeptic patients in areas with low prevalence. Endoscopy remains the method of choice for elderly dyspeptic patients and for those with possible gastric or duodenal pathology.

Pneumatic dilation of cardiac achalasia using low compliance balloon: University-Hospital experience.

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